one way to go Health cover with peace of mind

Transcription

1 one way to go Health cover with peace of mind July 2015

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3 Contents It s your choice... 2 New to private health cover?... 3 Unravelling the maze... 4 Helping you choose your cover... 6 Hospital cover... 8 Extras cover Ambulance cover How do I? I want to know about... 18

4 It s your choice This brochure has been designed to help you choose the right private health cover. Following the simple steps throughout this brochure will help you understand the different types of health cover onemedifund offers and will help you to make the right choice to suit your personal needs and budget. We want to make choosing private health cover for you and your family as easy as possible, so if at any time you do not completely understand the information contained in this brochure, just pick up the phone and call to speak to one of our customer service specialists. They will explain everything you need to know about health cover and help you choose the right cover to suit your needs. You can start your health cover by sending in the enclosed application form, over the phone, or on our website for immediate peace of mind. 2 onemedifund

5 New to private health cover? At onemedifund we know that health cover can be confusing and we aim to help you choose the right health cover product for you and your family. If you have any questions, please feel free to call us on between 8:30am & 5pm AEST, Monday to Friday. onemedifund health covers are especially designed to: cover you against high & rising hospital, medical & other healthcare costs at competitive rates give you the option to select your doctor and avoid hospital waiting lists through access to private hospitals cover your dependent children on your family cover until the age of 18 (or 25 if they re studying full-time) at no extra charge If you re new to health cover, there are a few important things you need to be aware of: 1. rivate health cover rivate health cover is designed to complement Medicare, not replace it. rivate health cover contributes towards the cost of public and private hospital treatment and health services not covered by Medicare. For a comprehensive outline of exactly what you re covered for, please see the product descriptions on pages Medicare Levy Surcharge The Medicare Levy Surcharge (MLS) applies to Australian taxpayers who do not have private hospital cover and who earn above a certain income. If you take out either of our Hospital covers you will avoid having to pay the MLS. (see page 20 for full details) 3. Australian Government Rebate on rivate Health Insurance The Australian Government Rebate on private health insurance was introduced as a financial incentive to assist Australians purchase private health cover. The Rebate is income tested and applies to all onemedifund products. The Rebate you receive is dependent on your household income, age, inflation (CI) and average health fund increases using a complex Government formula. (see page 20 for full details) 4. Lifetime Health Cover loading The Lifetime Health Cover loading will increase the standard rate for hospital cover by 2% for each year that you are over the age of 31 as at the date that you take out a hospital cover. (please see page 22 for full details) one way to go 3

6 Unravelling the maze Hospital cover onemedifund rivate lus Hospital cover provides benefits for private and public hospitals and has the option of an excess to reduce your premium. This excess is the maximum amount a patient pays if hospitalised in a financial year ($250 per person and $500 per family). Other than the excess, the benefits payable are identical for each cover option. It is strongly recommended that you take out Hospital cover. See pages 8-11 for details rivate lus Hospital No excess or rivate lus Hospital $250/$500 excess Extras cover Extras cover provides benefits for services that are not covered by Medicare. This includes dental, optical, physiotherapy, chiropractic, pharmacy, natural therapies, ambulance and more. It is important to understand that it does not include any hospitalisation expenses. It is essential to choose Hospital cover for this. See pages for details Extras lus or Basic Extras Combination packages You can mix and match any Hospital and Extra cover options. This is known as a combination cover. Follow these easy steps to choose your combination cover: See pages 8-15 for details Step 1 Choose your level of Hospital cover from the options above (rivate lus Hospital, with or without an excess) Step 2 Choose the level of Extras cover you prefer (Extras lus or Basic Extras) Step 3 Add them together (the rates can be found at the back of this brochure or on our website). 4 onemedifund

7 If you change your mind We are committed to helping you choose the health cover that is right for you. If for any reason you decide that your choice was not suitable then we will provide you with a refund (provided no claims have been made). You will need to contact us within the first 30 days of taking out your cover or changing your level of cover for this refund to be available. one way to go 5

8 Helping you choose your cover This table shows the most popular Hospital and Extras covers to suit each life stage. Step 1 Step 2 Step 3 choose your life stage our suggestion view pages Young singles You have finished studies or have started working. You only require cover for services you need and don t want to pay for services you don t expect to use. You need cover suited to your lifestyle and budget. Hospital cover rivate lus $250/$500 Extras cover Basic Extras pages 8-11 pages Married no children You are married, have settled down and are planning for the future. Getting ahead is important and you don t want to neglect your health. You need a suitably priced cover that offers more comprehensive benefits. Hospital cover rivate lus - $250/$500 Extras cover Extras lus pages 8-11 pages Married planning to have children You are planning for a family and good health cover and value for money is important. You need a cover that sets you up for the future and provides a good starting point for the new arrival. (lease note a 12 month waiting period applies for obstetrics. lease see page 18). Hospital cover rivate lus - No excess Extras cover Extras lus pages 8-11 pages Married with children You and your family are settled into a home and protecting the health of your loved ones is important. You want a comprehensive cover that provides for the health needs of everyone in your family. You can keep your children on your cover until they are 18 (or 25 if they are studying full time) Hospital cover rivate lus - No excess Extras cover Extras lus pages 8-11 pages Older eople You are a mid-age single, or senior couple or a family whose children are now independent. You are financially well established, leading a comfortable lifestyle and you want a quality cover at this stage of life. Hospital cover rivate lus - No excess Extras cover Extras lus pages 8-11 pages onemedifund

9 Step 4 Step 5 it s your choice applying for your health cover If you prefer other combinations/ options you may choose any Hospital cover (pages 8-11) and/or Extras cover (pages 12-13) to suit your personal circumstances. Complete the enclosed Application form Sign up online at hone us on Important Note: We strongly recommend you take Hospital cover in all cases. one way to go 7

10 Hospital cover We make selecting your Hospital cover easy! Our rivate lus Hospital gives you comprehensive cover for most public and private hospital services 365 days per year. You can choose to have no excess or a $250/$500 excess to reduce your health fund contributions. rivate lus Hospital cover Excess options ublic or private hospital bed shared or private room Same day patient fees Theatre fees Intensive care In hospital pharmacy Medical gap Obstetrics Cardio thoracic services Assisted reproductive services sychiatric Rehabilitation Eye surgery Joint replacement Reconstructive services Dialysis Other Medicare eligible services Services where no Medicare benefits are payable Cosmetic surgery National ambulance cover No excess or $250/$500 excess lease note: waiting periods (including those for pre-existing conditions) and excesses may apply. O O 8 onemedifund

11 Hospital excess You can reduce your contribution rate by choosing an excess. The excess is the maximum amount you pay up front if you are admitted to hospital in a financial year. ublic hospital or day surgery: You pay half the excess. The good news is, that no matter how many times you go to hospital during a year, you only pay a maximum $250 excess per person (or $500 per family) per financial year. Key features Comprehensive cover for most public and private hospital services 365 days per year. rivate lus provides benefits for most public and private hospital services, subject to the excess level chosen. onemedifund has agreements with around 520 private hospitals nationwide. A small number of private hospitals do not have a current agreement with the fund and a personal payment may apply. All hospital cover options provide medical gap benefits (known as Access Gap) through agreements with more than 35,000 doctors. This is designed to eliminate or reduce out of pocket costs for medical expenses. See page 21 for more information on Access Gap. All services eligible for Medicare benefits are eligible for hospital benefits under these health products. All hospital cover options include national coverage for ambulance services. We cover most public hospital stays, unless they charge over the Commonwealth default rate. lease contact us before you go into hospital for more details. Health rograms Our Hospital cover includes free health program options to help keep you healthy. My Health Online gives you access to a range of health and wellbeing tools through our My Health Online web portal. You can store e-health information about yourself and share it with your doctor, keep a calendar of healthcare appointments, complete a Health Risk Assessment, access a health library and more. Home makes it easy to get out of hospital early and receive personal care in your home. In some cases, you may be able avoid a hospital stay altogether if the healthcare services you need can be provided at home. Strive for Health has been developed to assist contributors with chronic conditions manage their health with the help of expert telephone or face to face support at home. Home helps you recover in the comfort of your own home with short term therapy for joint replacements, fractures, spinal conditions, stroke, respiratory conditions, cardiac conditions and mobility problems. We offer physiotherapy, occupational therapy and more. one way to go 9

12 Hospital cover What we will pay benefits towards: rivate lus Hospital public or private hospital bed - shared or private room (if available) same day patient fees theatre fees intensive care labour ward in hospital medical services in hospital psychiatric treatment in hospital rehabilitation treatment in hospital pharmacy surgical prostheses, up to the benefit listed on the Government s rostheses List (refer to page 13) ambulance services (refer to page 15) What we will not pay benefits towards: services incurred before waiting periods have been served (see page 18). any treatment for which Medicare does not pay a benefit, including cosmetic surgery services that are provided outside the Commonwealth of Australia services where an entitlement exists or may exist under any compensation, third party or other insurance a claim for a service that is submitted more than 24 months after the date of service Doctors fees (including Gs, specialists, radiology, pathology etc.) for services that are not part of a hospital admission. Services are not covered until the contributor is admitted to hospital (visits to hospital Emergency departments and for diagnostic services are not covered). outpatient services other than where included in an agreement between the fund and the hospital take home drugs and some high cost drugs or drugs that are not deemed to be related to the reason for your admission to hospital prostheses items that are not included on the Commonwealth Government approved list ambulance subscriptions or state-based ambulance levies ambulance costs that are covered under Government legislation or other compensable sources 10 onemedifund

13 Other Important Information rostheses Many hospital procedures include the use of prosthetic items (surgically implanted medical devices, such as hip and knee joints and heart pacemakers). You may have an out-of-pocket cost in relation to your prosthesis, depending on how your doctor charges for it. We will pay the benefit listed on the Government s rostheses List, and if your doctor charges above that amount, you pay the difference as an out-of-pocket expense. What should you do? Before you have any surgery, check your level of cover with the fund. If your surgery requires a prosthesis, ask your surgeon which will be best for you and which no gap prostheses are available. If the surgeon recommends a prosthesis and a gap is payable, ask why this is being recommended. Ask the surgeon to explain the cost of the surgery, including the prosthesis. If there are any gaps for you to pay ask for a written cost estimate. Contact the fund again to confirm if your surgery will involve any gap payments. Waiting periods lease refer to page 18 for information about waiting periods for this cover. re-existing conditions lease refer to page 18 for information about preexisting conditions Medicare Benefits Schedule & Access Gap lease refer to page 21 for more information. one way to go 11

14 Extras cover We make selecting your Extras cover easy... Choosing an Extras cover is easy. We have 2 different levels to suit your needs and budget Extras lus and Basic Extras. Here is a summary of what we cover. To get the full product information please contact us or download a cover description from lease keep in mind that each service has a limit and waiting periods may apply. What we will pay benefits towards: Service Extras lus Basic Extras (as at July 2015) Benefit Annual limit Benefit Annual limit General dental Basic restoration (fillings) Diagnostic services Oral surgery eriodontics Set benefits per item No annual limit 75% of cost $550 High cost dental Optical harmacy hysiotherapy and other therapy Endodontics Crowns & bridges Dentures Set benefits per item $1,000 ($1,500 loyalty limit) O O $650 ($800 loyalty limit) O O Implants $1,000 O O Orthodontics Glasses / frames & contact lenses Laser eye surgery rescriptions only Note: Benefit applies after the maximum BS amount ($37.70 as at 1/1/15) has been deducted hysiotherapy Occupational therapy 100% of cost 100% of cost $65 per script $500 / $1,000 Initial consult $60 Standard consult (first 10) $40 Standard consult (11+) $30 Initial consult $60 Standard consults $40 Lifetime Limit $2,100 ($2,600 loyalty limit) O O $ % of cost $180 $500 per eye $1,000 every 2 years O O $550 / $1,100 75% of cost $50 per script $500 / $1,000 75% of cost $350 / $700 O O Hydrotherapy 80% of cost to $15 $200 / $400 O O Overall physio limit $550 / $1,100 $350 / $700 lease note: each service has a limit and waiting periods may apply. 12 onemedifund

15 Service Extras lus Basic Extras continued Benefit Annual limit Benefit Annual limit Complementary therapies Chiropractic x-rays 80% of cost $115 / $230 Chiropractic Remedial massage Osteopathy Myotherapy Homeopathy Naturopathy Herbal medicine (Chinese or western consultation only) Initial consult $40 Standard consult (first 10) $30 Standard consult (11+) $20 $435 / $870 75% of cost $350 / $700 Acupuncture Additional benefits odiatry Dietetics O O 80% of cost $250 / $500 O O Orthotics (limit each 2 years) Overall complementary therapies limit $750 / $1,500 $350 / $700 re / ost-natal classes 80% of cost $150 O O Home nursing 80% of cost up to $45 per visit / $90 per day $1,000 O O Hearing aids $80% of cost $1,500 per 5 years O O sychology 80% to $120 (initial) $500 / single or $80 (subsequent) or $650 / family O O Allergy treatment 80% of cost $100 O O Surgical equipment / health aids (sub-limits apply. Contact us for more info) 50% of cost to $400. Loyalty benefits apply 80% up to $1,000 after 5 years cover. Contact the fund for details. $400 ($1,000 loyalty limit) O O Health management programs Travel expenses (for in-patient services) 100% of cost 20c/km $150 / single or $300 / family 75% of cost $100 / single or $200 / family Up to $100 / single and $200 / family O O Speech therapy 80% of cost $800 O O Ambulance National ambulance cover 100% of cost No annual limits 100% of cost No annual limits lease note: each service has a limit and waiting periods may apply. one way to go 13

16 Extras cover What we will not pay benefits towards: services incurred before waiting periods have been served (see page 18) services where a Medicare benefit is payable products from or services provided outside the Commonwealth of Australia services where an entitlement exists or may exist under any compensation, third party or other insurance a claim for a service that is submitted more than 24 months after the date of service prescriptions less than the standard BS amount ($37.70 as at 1 January 2015) or over the counter medications optical appliances not requiring sight correction services provided by Extras providers not registered or recognised by the fund or with Medicare or the Australian Regional Health Group services provided by family members, relatives, business or practice partners or yourself Registered providers It is a requirement that any Extras provider is registered with Medicare or the Australian Regional Health Group, and recognised by the fund before benefits will be paid. Our aim is to ensure the safety and appropriateness of treatment to our contributors and we will only pay benefits for providers who are deemed to have met the fund s recognition criteria. We reserve the right to refuse payment for services rendered by a provider who does not satisfy the fund criteria. If you wish to ensure that the provider you are attending is covered by the fund you can search for registered providers on our website or contact us prior to treatment. Other important information Annual limits are for a financial year (1 July 30 June) and are per person unless stated otherwise. Optical benefits (glasses and contact lenses) are paid only when prescribed by a registered optometrist. Benefits will only be paid where sight correction is necessary. No benefit is payable for non-prescription sunglasses. harmacy benefits apply after the standard harmaceutical Benefit Scheme (BS) amount has been deducted. The BS amount changes every year on 1 January and is $37.70 as at 1 January This means that you will pay the first $37.70 yourself and then onemedifund pay a percentage of the balance depending on the level of your Extras cover. Complementary therapies benefits are payable on fund recognised services and the provider must be registered or recognised by the fund or registered with Medicare or the Australian Regional Health Group. Loyalty limits apply after 5 years of continuous cover on Extras lus. lease contact the fund on before you have your treatment so we can tell you how much you will get back. 14 onemedifund

17 Ambulance cover Ambulance cover provides benefits for ambulance treatment and/or transport should you suffer a sudden illness or accident. Ambulance cover is included in all onemedifund Hospital, Extras and Combination covers. What we will pay benefits towards: 100% reimbursement for the cost of treatment received, irrespective of distance travelled within Australia unlimited cover for land, air and sea ambulances There is no annual limit on ambulance services and there is no waiting period. What we will not pay benefits towards: ambulance subscriptions or state based ambulance levies ambulance costs that are covered under government legislation or other compensation sources ambulance services that are not medically necessary one way to go 15

18 How do I... Commence health cover with onemedifund Starting onemedifund health cover is easy! Simply choose the best level of cover for you, either Hospital only, Extras only, or a Combination cover (recommended), then choose how you d like to sign up. Online hone send a completed application form to info@onemedifund.com.au Fax send a completed application form to Mail send a completed application form addressed to: onemedifund Locked Bag 25, Wollongong NSW 2500 An application form is enclosed at the back of this brochure. Transfer from another health fund Transferring from another health fund is easier than you think. It takes around 5 minutes and you can switch over the phone, online or by sending in your application form. You won t have any waiting periods that you have already served with your previous health fund provided that you had an equivalent or higher level of cover with that fund. To switch, simply start your onemedifund cover from the same day you cease your previous cover. We will request a Clearance Certificate on you behalf and credit you with the waiting periods you have already served. If you have used all of your annual limits with your previous fund, you may have to wait for the new financial year for these limits to be reset Change or upgrade my cover You can change or upgrade your cover to one that better suits your needs at any time. Simply log in to Online Services on our website, us at info@onemedifund.com.au or call us on Apply for the Australian Government Rebate on rivate Health Insurance You may be able to reduce your regular health fund contributions by completing the Australian Government Rebate on rivate Health Insurance form included on the onemedifund application form. Alternatively, us at info@onemedifund.com.au, call us on to request the form, or download it from our website, onemedifund will automatically reduce your contributions to take out your nominated Rebate amount once you submit your rebate application form. For more information see pages Nominate or change my Rebate Tier You can nominate or change your rebate tier at any time, simply: visit complete our Rebate Tier Nomination Form, available on our website, and return it to Locked Bag 25, Wollongong NSW 2500 call us on or info@onemedifund.com.au Find a registered healthcare provider To find out whether your Hospital, Access Gap doctor or Extras provider is recognised by onemedifund, go to us at info@onemedifund.com.au or call us on Make an Extras claim Claiming is easy, simply choose the option that best suits you and we can pay your benefit straight into your nominated account. Electronic Upon commencing health cover, all onemedifund contributors are given a HICAS card, which they can use to claim their benefit EFTOS style at the time of treatment. More than 36,000 practitioners Australia wide use HICAS, including dentists, physiotherapists, optical dispensers, chiropractors, osteopaths, occupational therapists, psychologists and podiatrists. Just swipe your card at the time of service, sign for the service to validate the claim and pay the gap (if applicable). This means that you do not need to lodge a claim manually, as onemedifund pays your benefit directly to the practitioner. lease note: You must treat your HICAS card like you would a credit card and sign only for services provided. Make sure that you maintain personal control over your card at all times. Additional cards are available for other members of your family upon request. lease report any lost or stolen cards to onemedifund immediately. Online You can claim for a range of Extras benefits at See page 17 for a full list of services. Mail Simply complete a claim form, attach all accounts and/or receipts and post them to: onemedifund Locked Bag 25, Wollongong NSW 2500 Fax Complete a claim form, attach copies of all accounts and/or receipts and fax them to onemedifund

19 Complete a claim form online or scan your completed claim form and a copy of all accounts and/or receipts and them to info@onemedifund.com.au Make a medical claim Access Gap Your doctor should advise you of any amounts payable before your admission to hospital. Your doctor will usually send the claim directly to onemedifund for payment and you will receive an advice of the benefits we have paid. Electronic onemedifund participates in the Australian Government electronic claiming system for doctors and hospitals known as ECLISE. Where the ECLISE service is used, there is no need to submit a claim form to onemedifund Claim Form Simply complete a claim form, attach the Medicare Benefits Statement and send them to onemedifind using one of the following methods: Mail onemedifund Locked Bag 25, Wollongong NSW 2500 Fax info@onemedifund.com.au Make a hospital claim The hospital should check your level of cover and benefits with onemedifund and advise you of any amounts payable before your admission. On discharge, you should check the account carefully to ensure that all details are correct. The hospital will send the claim directly to onemedifund for payment, and you will receive an advice of the benefits we have paid. Use Online Services Using our Online Services is an easy, convenient, costeffective way of managing your health cover 24 hours a day, 7 days a week. Claim online Claiming online is easy! You can claim up to a maximum of $200 a day for a range of Extras services at including: Dental Optical (glasses & contact lenses) Chiropractic hysiotherapist odiatry Occupational therapy Speech therapy All you need to do is log in to online services and fill in the details from your receipts. Your claim is processed automatically and your benefit is paid straight into your account. You don t even need to send in your receipts for certain claims under $200 (but you do need to keep all your receipts as we may ask for them later to check some of the information). Claims that are over $200 can still be completed online, but before payment is made you will need to send in or upload a scanned copy of your receipts. Make a contribution payment Direct debit is the most efficient way for you to pay your contributions and ensures that your cover is always current and benefit entitlements are maintained. onemedifund does not charge any additional fees for this service. All you need to do is complete and return the Direct Debit Request Authority included with the application form. This will ensure automatic deductions from your bank account. You can also pay your contributions by BAY. Our BAY Biller Code is lease contact us for your Customer Reference Number. You can use our secure Online Services to: choose the cover that s right for you commence cover with onemedifund claim online (see next column) view or change your contributor details view your claims history download forms and brochures order a HICAS card find a healthcare provider (hospital, Access Gap doctor or Extras provider where you can use your HICAS card) print your annual tax statement complete a Health Risk Assessment (if you hold Hospital cover) one way to go 17

20 I want to know about... Waiting periods and continuity of cover Waiting periods are established to protect all contributors by encouraging people to maintain their health cover. A waiting period is a length of time applied to each new health cover and also applies when cover is upgraded. During this period, benefits are not payable. onemedifund will provide continuity of cover for anyone transferring from another health fund or from another onemedifund product provided that equivalent or a higher level of cover was held. To be eligible for continuity of cover, the transferring health cover must be financial, all waiting periods from the previous fund must have been served and a clearance certificate provided. lease note that if you upgrade from Extras only to Hospital cover, full hospital cover waiting periods will apply. Service Waiting period Hospitalisation related to an accident Nil Ambulance Nil Transfer from another fund or upgrading your onemedifund health cover 2 months On starting new health cover (apart from these noted below) 2 months Rehabilitation, psychiatric and palliative care 2 months Health programs 2 months Optical benefits & health management programs High cost dentistry including crowns, bridgework, implants, orthodontics and dentures 6 months 12 months Obstetrics or related conditions 12 months re-existing conditions Any ailment, illness, or condition that you had signs or symptoms of (in the opinion of a medical practitioner appointed by the health insurer) that existed during the 6 months prior to you commencing hospital cover or upgrading to a higher hospital cover. It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you had not seen your doctor about it before commencing hospital cover or upgrading to a higher hospital cover. Note: This waiting period applies to Hospital cover only, and does not apply to Extras cover. 12 months Laser eye surgery and hearing aids 24 months For more information on waiting periods, clearance certificates or continuity of cover please call or info@onemedifund.com.au. 18 onemedifund

21 Medicare Benefits Schedule & Access Gap The Medicare Benefit Schedule (MBS) is a list of fees for medical services issued by the Commonwealth Government. If you have private health cover and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS and the remaining 25% is paid by onemedifund. If a doctor raises a charge that is above the MBS, this amount is known as a medical gap. onemedifund has arrangements with more than 35,000 doctors Australia wide where additional benefits are payable by the fund to reduce or eliminate medical gaps faced by contributors. This scheme is known as Access Gap. Before admission to hospital you should ask your doctor/s to inform you of all medical fees that may be charged and whether he/she participates in our Access Gap scheme. If the doctor/s elects not to participate in the Access Gap scheme and charges a fee above the MBS, this additional amount will need to be paid by you. Before any hospital treatment you should confirm all charges with your doctor/s. We can help you identify whether your doctor participates in the Access Gap scheme. Call us on Excess options Choosing an excess allows you to reduce your standard contribution rate. In these circumstances, if you are admitted to hospital, you agree to pay an amount up front towards the cost of your hospitalisation. For each Hospital product a per person excess applies together with an annual maximum each financial year (1 July 30 June). As a special feature, the excess payable for day only treatment or for any public hospital admission, is only half of the standard per person excess. one way to go 19

22 I want to know about... Australian Government Rebate on rivate Health Insurance The Australian Government Rebate on rivate Health Insurance was introduced as a financial incentive to help Australians afford private health cover. The Rebate is income tested and applies to the standard contribution of all onemedifund products. The Rebate is not available for the Lifetime Health Cover loading portion of your contributions (if applicable). The amount of Rebate you are entitled to depends on your taxable household income for Medicare Levy Surcharge purposes, the age of the oldest person on your health cover, inflation (CI) and average health fund industry increases using a complex Government forumla. If you would like to claim your Rebate up front as a reduced contribution, you will need to register for the Rebate and nominate a Tier. If you don t nominate a Tier, or if you choose the wrong Tier, the Australian Tax Office will reconcile any differences when you lodge your annual tax return. Medicare Levy Surcharge The Medicare Levy Surcharge (MLS) applies to Australian taxpayers who do not have private hospital cover and who earn above a certain income ($90,000 for singles and $180,000 for couples and families in the 2015/16 financial year). The surcharge aims to encourage individuals to take out private hospital cover and, where possible, to use the private system to reduce the demand on the public system. The surcharge is calculated between 1% and 1.5%, dependent on your household income (see the table on the next page). It is in addition to the Medicare Levy of 1.5%, which is paid by most Australian taxpayers. The MLS is imposed on individuals earning over the income threshold who do not have an appropriate level of hospital cover. The income threshold changes each financial year. You do not have to pay the surcharge if your household income is below the income threshold. All onemedifund hospital covers exempt you from the MLS. Most people choose to claim their Rebate up front as a lower contribution, but if you would prefer to claim your Rebate as a lump sum through your tax at the end of the financial year, you can elect to pay the full contribution rate. If you re unsure which Rebate Tier you should nominate, please contact your tax agent, financial advisor, the Australian Taxation Office or visit A table to help you determine your Rebate Tier is on the next page. 20 onemedifund

23 Step 1: Income threshold (for 2015/16 financial year) Step 2: Age & Rebate amount (age of the oldest person on your cover) Under 65 yrs yrs 70+ yrs Medicare Levy Surcharge (this will apply if you don t have private hospital cover) Base Tier Tier 1 Tier 2 Tier 3 Single $90,000 or less Family* $180,000 or less Single $90, ,000 Family* $180, ,000 Single $105, ,000 Family* $210, ,000 Single $140,001 or more Family* $280,001 or more % % % 0% % % % 1% 9.273% % % 1.25% 0% 0% 0% 1.5% * If you are a family with children, the income threshold for each tier is increased by $1,500 for every child after your first. Family includes couples. For the most up-to-date information, visit one way to go 21

24 I want to know about... Lifetime Health Cover Lifetime Health Cover (LHC) commenced on 1 July 2000 as a Commonwealth Government initiative to reward persons who maintain hospital cover. LHC recognises the length of time a person has had private hospital cover with a registered health fund. If you start your cover earlier in life and maintain your Hospital cover you will pay a lower contribution rate each year compared to someone who starts their cover at a later age. The main points to remember are: eople who purchase Hospital cover for the first time after 1 July following their 31st birthday will pay a Lifetime Health Cover loading. This loading is based on the person s Lifetime Health Cover age. The loading is 2% for each year the person s Lifetime Health Cover age is over 30 years old. Once you take out Hospital cover, your loading is locked in at the same rate, rather than increasing 2% each year. The loading only applies to Hospital cover. The maximum loading is 70% which applies to those 65 years or over. Lifetime Health Cover loadings revert to 0% after 10 years continuous hospital coverage. The Australian Government Rebate is not available for the LHC loading portion of your contributions. rivacy olicy onemedifund complies with the requirements of the rivacy Act 1988 and Australian rivacy rinciples. If you would like a copy of our full rivacy olicy, visit Complaints Handling onemedifund is committed to the efficient and fair resolution of all complaints and has a policy to ensure this. If you have a complaint that you wish to discuss, please contact us on or info@onemedifund.com.au. We will promptly respond or direct you to the appropriate individual or manager to handle the complaint. If we are unable to assist you, you can contact the rivate Health Insurance Ombudsman (HIO) on , info@phio.gov.au or visit HIO is free, independent and protects the rights of people with private health cover. If you would like a copy of our Complaints Handling olicy, you can download it from Code of Conduct This Code was developed by rivate Healthcare Australia (HA) and HIRMAA (representing restricted and regional health funds). As well as promoting improved standards and clarity of information (including privacy) given to contributors, it aims to solve problems between contributors and onemedifund through internal dispute resolution. The Code also ensures that funds inform their contributors of their entitlement to seek assistance from an external dispute resolution body, such as the rivate Health Insurance Ombudsman (HIO). 22 onemedifund

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26 Need more information? Just call our friendly staff on We look forward to assisting you with any enquiry! The information in this brochure is subject to change. For the most up-to-date information, visit lease read this brochure carefully and retain for future reference.

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28 Locked Bag 25, Wollongong NSW 2500 National Health Benefits Australia ty Ltd (trading as onemedifund). A registered private health insurer. ABN V1.0